Healthcare Provider Details

I. General information

NPI: 1508101254
Provider Name (Legal Business Name): BEST FRIENDS ADULT ACTIVITY CTR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 S GREEN ST
LONGVIEW TX
75601-7536
US

IV. Provider business mailing address

3839 GILMER RD
LONGVIEW TX
75604-1132
US

V. Phone/Fax

Practice location:
  • Phone: 903-753-1795
  • Fax: 903-753-1795
Mailing address:
  • Phone: 903-295-1237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: MS. STEPHANIE R ROYAL
Title or Position: PRESIDENT
Credential:
Phone: 903-753-1795